Nevada Medicaid and Nevada Check Up News (Fourth Quarter 2025 Provider Newsletter) [Read]

Attention Behavioral Health Providers: Monthly Behavioral Health Training Assistance (BHTA) Webinar Scheduled [See Web Announcement 2009]

Attention All Providers: Requirements on When to Use the National Provider Identifier (NPI) of an Ordering, Prescribing or Referring (OPR) Provider on Claims [Announcement 850]

If you are a Medicaid provider whose revalidation application has not been processed by your termination due date, you will be ineligible to provide services to any Nevada Medicaid or Nevada Check Up recipients, including both Fee-for-Service and Managed Care Organization (MCO) enrolled recipients. See Web Announcement 1265

Enrollment Termination Frequently Asked Questions (FAQs) [Review]

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NOTIFICATION: Some Provider Flex services will be temporarily unavailable due to scheduled maintenance from 7 p.m. Pacific Time on Friday, March 6, 2026, to 11 a.m. Pacific Time on Saturday, March 7, 2026.

During this time:
  • New enrollment applications cannot be started.
  • Revalidation and Update applications will remain available; and
  • Previously started applications can still be accessed and resumed.

URGENT NOTIFICATION: Update regarding the Electronic Visit Verification (EVV) claims processing error. Nevada Medicaid did not receive some claims from Sandata (Optum) in time for the February 06, 2026 financial cycle. The issue was resolved this week. EVV providers can contact Sandata Technologies at (833) 545-0394 or support@sandata.com for assistance.

Known System Issues-Click HERE

Top 10 Claim Denial Reasons and Resolutions/Workarounds for January 2026 Professional Claims. See Web Announcement 3840.

Top Prior Authorization Denial Reasons for the Fourth Quarter of 2025. See Web Announcement 3830.

Attention Providers Using the Authorization Criteria Function: Results that return prior authorization (PA) requirements are accurate. For results that return “There are no records found based on the search criteria,” there may be a PA requirement if limits have been exceeded. To verify PA requirements, please refer to the Medicaid Services Manual (MSM) Chapter for your service type at dhcfp.nv.gov and the Billing Guide for your provider type at www.medicaid.nv.gov.

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During the scheduled site maintenance window the Provider Web Portal will be unavailable. The table below shows the regularly scheduled maintenance window. All times will be in the Pacific time zone.

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471. Opioid_Use_Disorder_Agents_2019-12.pdf
... Opioid Treatment Program. In addition, DATA reduced the regulatory burden on physicians who choose to practice opioid addiction therapy by permitting qualified physicians to apply for and receive ...
Terms matched: 1  -  Score: 16  -  21 Oct 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Opioid_Use_Disorder_Agents_2019-12.pdf
472. Anticonvulsants_2019-12.pdf
... Pharmaceuticals; November 2017. ï ‚ Post RM. Bipolar disorder in adults: choosing maintenance treatment. UpToDate Web site. www.uptodate.com. Updated November 2, 2017 ...
Terms matched: 1  -  Score: 10  -  21 Oct 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Anticonvulsants_2019-12.pdf
473. DHCFP_EVV_Selection_Form.pdf
... _ EVV VENDOR SYSTEM SELECTIONS: (Choose only one EVV vendor system to be ... through a Medicaid Managed Care Organization (MCO) . (effective date: ___ ...
Terms matched: 2  -  Score: 39  -  21 Oct 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/DHCFP_EVV_Selection_Form.pdf
474. NV_EnrollmentChecklist_PT14_Spec306.pdf
... acknowledge in writing that they understand their right to select a qualified provider of their choosing; 7. Only qualified providers provide prescribed services within scope of their practice ...
Terms matched: 1  -  Score: 20  -  15 Oct 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_EnrollmentChecklist_PT14_Spec306.pdf
475. NV_EnrollmentChecklist_PT14_Spec307.pdf
... acknowledge in writing that they understand their right to select a qualified provider of their choosing; 7. Only qualified providers provide prescribed services within scope of their practice ...
Terms matched: 1  -  Score: 20  -  15 Oct 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_EnrollmentChecklist_PT14_Spec307.pdf
476. NV_EnrollmentChecklist_PT14_Spec305.pdf
... acknowledge in writing that they understand their right to select a qualified provider of their choosing; 7. Only qualified providers provide prescribed services within scope of their practice ...
Terms matched: 1  -  Score: 20  -  15 Oct 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_EnrollmentChecklist_PT14_Spec305.pdf
477. Anthem_DUR_Binder_Oct_2019.pdf
... Presented to NV DUR Board on October 17, 2019 1 DRUG USE REVIEW BOARD MCO PRIOR AUTHORIZATION CRITERIA REVIEW FORM Clinical criteria for drugs or drug classes listed on ...
Terms matched: 1  -  Score: 126  -  19 Sep 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Anthem_DUR_Binder_Oct_2019.pdf
478. SilverSummit_DUR_Binder_Oct_2019.pdf
... Standard DUR Reports 54 Natroba & Lice Treatments Clinical Presentations 3 DRUG USE REVIEW BOARD MCO PRIOR AUTHORIZATION CRITERIA REVIEW FORM Clinical criteria for drugs or drug classes listed on ...
Terms matched: 1  -  Score: 120  -  19 Sep 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/SilverSummit_DUR_Binder_Oct_2019.pdf
479. E-Binder_SSSB_September_2019.pdf
... , 2019. ï ‚ Stovall J. Bipolar mania and hypomania in adults: choosing pharmacotherapy. UpToDate website. 2019[b ] . www.uptodate.com/ . Accessed ...
Terms matched: 1  -  Score: 21  -  04 Sep 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/E-Binder_SSSB_September_2019.pdf
480. NV_BillingGuidelines_PT17_Specialty_181_20190201.pdf
... to pay FQHCs providing services under a contract with a Medicaid Managed Care Organization (MCO; also known as a Managed Care Entity [MCE]) supplemental payments ...
Terms matched: 1  -  Score: 23  -  30 Aug 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT17_Specialty_181_20190201.pdf
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